HEALTH CARE LAW/ MEDICAL LAW & ETHICS- The Doctor-Patient Relationship

Medical Law and Ethics 1 – The Doctor-Patient Relationship
by Dr Ernest Owusu-Dapaa

The doctor-patient relationship is one of the most sensitive, complex, and ethically significant relationships in law and medicine. Unlike many professional relationships, it inspires deep emotional responses – admiration when trust is honoured, resentment when betrayed. A single moment of insensitivity can transform respect into hostility, as illustrated in both real-life accounts and notorious cases such as Harold Shipman and GP Clifford Ayling.

Core Duties in the Relationship
Under GMC Good Medical Practice (2006), doctors must be polite, considerate, honest, treat patients with dignity and individuality, respect privacy and confidentiality, and support patients in caring for themselves. Ethical failure here erodes both individual trust and public confidence in the profession.

Goals of Medicine
Traditionally, medicine aims to save and extend life, promote health, and relieve pain. The WHO defines health as complete physical, mental, and social wellbeing. Contemporary goals include disease prevention, care of the incurable, avoidance of premature death, and promotion of a peaceful death. The Ghana Medical Association affirms health as a right, stressing accessibility, equity, safety, and the total wellbeing of the population.

Models of the Doctor-Patient Relationship (Veatch, 1972)

Fiduciary/Trustee Model: Patient entrusts health to the physician, who acts in their best interests.

Priestly Model: Paternalistic; beneficence outweighs autonomy.

Engineering Model: Doctor presents facts, patient makes all decisions – risks moral detachment.

Customer-Sales Model: Patient as “customer,” doctor as service provider – undermines moral responsibility.

Collegial/Partnership Model: Shared decision-making, equality of dignity – difficult in reality due to power imbalance.

Contractual Model: Negotiated obligations and benefits, respecting autonomy and moral integrity, but still limited by systemic inequalities.

Four Principles of Bioethics in the Relationship

Non-maleficence: Obligation to avoid harm, including overriding an autonomous patient’s wishes as a harm in itself.

Beneficence: Positive duty to act for the patient’s benefit, constrained by autonomy and justice.

Autonomy: Self-governance, requiring capacity, informed choice, and freedom from controlling influences. Respect for autonomy demands truth-telling, consent, and meaningful choices, but it is not absolute.

Justice: Fair distribution of resources and treatment decisions based on clinical need.

Trust and the Relationship
Trust is central – patients permit examination, treatment, and disclosure of private information because they believe doctors will act in their best interests. This trust must be reciprocated: doctors should trust patients as moral agents capable of responsible decisions. A refusal to trust patients risks undermining respect for autonomy.

Power Imbalance and Potential Exploitation
The doctor’s knowledge and authority create opportunities for abuse, from unauthorised use of patient tissue (Moore v Regents of University of California) to non-consensual research participation. Canadian law in Norberg v Wynrib treats the relationship as fiduciary, focusing on power and trust; UK law, however, stops short of classifying it as fiduciary (Sidaway). Power imbalances can also allow patients to exploit doctors, as studies on sexual harassment of healthcare providers show.

Evolving Towards Equality
Modern healthcare increasingly rejects pure paternalism, favouring patient-centred care and shared decision-making. Cases like Montgomery v Lanarkshire Health Board [2015] UKSC 11 emphasise informed choice, with patients recognised as capable adults who accept responsibility for their medical decisions and associated risks. With this shift comes the recognition of patient responsibilities – honesty about medical history, lifestyle, and compliance with agreed care plans.

Key Discussion Questions:

What are the core ethical and legal elements of the doctor-patient relationship?

Should patients have reciprocal ethical duties, and if so, what are they?

Does reducing the doctor’s power risk undermining professional responsibility, or does it strengthen trust?

Conclusion
The doctor-patient relationship sits at the intersection of law, ethics, and human vulnerability. It is shaped by principles of beneficence, non-maleficence, autonomy, and justice, but also by evolving social expectations, legal developments, and the enduring need for trust. Balancing professional authority with patient autonomy remains a central challenge – one that demands both ethical vigilance and legal clarity.